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General NPI Number Information
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NPI Number | 1467816017
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Entity Type | Individual
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Provider Name | ROSE COPE PTA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 809 S BROAD ST SW
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City | ROME
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State | GA
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Zip | 30161-4654
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Country | US
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Telephone | 706-235-1337
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Fax |
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Provider Business Mailing Address
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Address Line | 18 GROVE PARK CIR
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8472
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Country | US
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Telephone | 706-331-8194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA003592
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License Number State | GA
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